| NPI | 1629220488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-2733) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT MT 543) |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2024-07-18 |